Symptoms and Decisions: Psychosis and Police-Led Psychiatric Crisis Intervention Outcomes

Abstract

Background:

This study examined how the presence of psychotic symptoms affects police decision-making during behavioral health crisis interventions, with a focus on outcomes of jail diversion, emergency department (ED) diversion, and involuntary hold.

Aims:

This study aimed to compare intervention patterns for individuals with and without psychotic presentations and to identify demographic, clinical, and operational factors associated with outcomes across groups.

Methods:

A retrospective analysis of 50,062 police-led crisis encounters recorded in the Massachusetts Department of Mental Health’s jail diversion program database between April 2023 and January 2025 was conducted, using stratified mixed-effects logistic regression with program location as a random effect.

Results:

Psychosis was present in 22.8% of all encounters and was associated with similar rates of jail diversion (87.9% vs. 84.7%) and ED diversion (43.1% vs. 54.3%), and higher rates of involuntary hold (26.1% vs. 11.5%). Assessment in home or community settings was associated with increased ED diversion across populations, while the presence of on-scene emergency or support personnel predicted involuntary hold. Among those with psychosis, charge severity, referral source, and prior police contact were associated with jail diversion, while mood disorder had a stronger association with involuntary hold in the non-psychosis group.

Conclusions:

Findings highlight the need for population-specific crisis response protocols that integrate clinical features, setting, and referral dynamics. Structured decision-making tools, co-response models, and expanded consultation roles for mental health professionals, including psychiatric nurses, may improve alignment between individual needs and intervention outcomes.

Keywords

forensic psychiatry psychosis crisis intervention schizophrenia legal/ethical issues emergency psychiatric nursing

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